In this article we will explore a case study as seen in a Chinese mental health clinic in Shanghai. The presenting case will look at the effects of China’s one-child-policy but in particular the strategies employed by parents to control children not living up to their expectations at an early age. We will also consider parental guidance in line with established treatment covering behaviourism and transactional analysis methodology.


In China in order to control a rising population and the threat of economic and social crisis the government of China regulate birth rates across the country. In order to supervise the population a strict law is enforced under the one child policy. Although human rights groups and Western ideology of freedom conflict with the Chinese population control methods such as forced abortion, abandonment of female children and the main cause of child kidnapping and trade the Chinese recognise the need for this policy or future starvation and social breakdown through over-population in the future is inevitable. Even at its present growth rate at one child per family, China will still have the largest population in the World with limited recourses to support such a growth rate.

However for psychologists the interest is more focused on the social consequences of this policy to the mental health of children born into homes with only adults for company and no siblings to interact with and learn from. In a previous paper we explored the problem with under-developed skills in empathy, social communication and relationships. In this paper we will focus on a single child as a case study that has generalised to a population that is now obsessed with educational attainment and social monitory success.

Case Study:

A Chinese mother brought her nine year old boy to a foreign psychologist practicing in Shanghai as a counsellor and psychology professor. The mother explained the boy’s problems in the following way:

Mother – “my boy eats very slowly at dinner times, the family all eat together but he will take almost one hour to eat and often just plays with the food pushing it about his plate. He also does not complete his homework for school and the teacher often complains to us about his slowness in class, his lack of friends and poor performance on tasks usually through his slowness to start and finish. In addition to this he often falls asleep at his desk at home and I have to wake him in order to get him to his bed.”

Psychologist: “how do you deal with his behaviour and what is his teacher’s normal response to his behaviour on class?”

Mother: “both the father and I shout and scream at him to finish his dinner or homework. We tell him what the teacher says about him and how he is making his parents lose face in front of her. When he is in class his teacher shouts and complains to him all the time – and often the other children think he is slow and unfriendly to them.

Psychologist: “What is the boy’s reaction to all this shouting and screaming that happens at home and school?

Mother: “he does not seem to care. He just carries on in his slow way. If we try to hurry him he will go into a tantrum until we leave him to continue with his meal or play.

Further information;

Although the interview went into further details about the boy’s behaviour the psychologist was more interested in the behaviour of those the boy interacts with on a daily basis. The family is a typical Chinese extended household with the father’s parents living in the same apartment with the child and mother. The mother is a professional who works normal day-time hours and the father works full time in a government post. The grandparents are retired and look after the boy as far as taking and picking up from school and feeding the boy when he comes home with snacks. When the boy arrives home from school he watches TV while the grandparents give him junk-food snacks until the mother arrives home from work and then with the grandmother cooks the evening meal. After the meal the boy plays computer games until his mother insists he starts his homework which often takes the boy until 11pm when his mother then forces him to bed.

The above case in actually very typical in China with one child dominating the household and all the focus of the adults is on the child’s welfare. In Eric Berne’s (1960’s) theory of Transactional Analysis, every child is an attention seeking vehicle, trying to keep himself as the centre of attention towards their parents. Early in the 1940’s Piaget, also talked about children as self-centred (egocentric) as only seeing the world around them from their point of view. Berne however in order to understand a child’s behaviour talked about the child’s mind containing a “little professor”, what Berne meant was children are always trying to figure out how to best get from adults their emotional needs met. In an ideal world this would be a positive loving experience that would benefit the child and parent. However in this busy modern world parents are short of time and need to hurry and process the child’s needs in an often negative way. As in our case study the parents are giving the child negative attention through shouting and screaming – the child not able to get positive attention therefore welcomes the negative as better than nothing. It would not be surprising in the past if the child was in fact often ignored by the grown ups when he is behaving quietly. In combination with T.A. the theory of B. F. Skinner in the 1960’s then based on the work of Pavlov (Russian) who experimented with learned behaviour through conditioning, Skinner showed that rewards rather than punishment led to greater changes in habitual behaviour patterns and that positive reinforcement gave direction.

The first step for the boy’s “little professor” was when he discovered that eating very slowly got him an enormous amount of attention as the adults discussed his “problem” and trying to persuade the boy to eat faster and stop playing with his food. Sometimes the parents would use bribery, such as if the boy eats quickly he can have extra time to play his computer games. This not working they (parents) became frustrated and turned to threats, shouting and screaming at the boy. While the boy feels upset, he continues to eat slowly as this strategy works in getting him the constant attention he desires. The homework is another continuation of this attention seeking. Having finished the meal now the boy can make sure the attention continues. He deliberately takes much longer to complete tasks for his homework. The parents in China are obsessed with educational attainment (one of the leading reasons for suicide by young people in the country) and worry that if their child falls behind at any age they will not be able to catch up and where parents rely on their own future well-being in that their one and only child be successful at work to pay towards their own future retirement. The boy then continues this strategy at school. He sees the female teacher as a mother figure and sees her reaction is the same as his parents. The teacher screams and shouts at him just like at home. So in order to get more attention he continues to work slowly, often not finishing his work. Despite the other children resenting him for taking up so much of the teacher’s time who is giving him support and constant pressure to finish. In a class of 20 children he gets more than 70% of the teacher’s time in class. For this boy – perfect.

Treatment Suggestions:

Having considered the problem as attention seeking behaviour brought about by the reactions of the parents and teacher to the boy’s slow behaviour the psychologist summed up the boys problems as three-fold:

1. Slowness of eating
2. Inability to finish homework in a reasonable time
3. Slow at classroom activities

Parental problems as;

1. Lack of insight into the boy’s needs
2. Punishment by emotional outbursts of shouting and screaming
3. Failure to set boundaries within the family

Process of treatment:

The psychologist suggested a stepped approach by dealing with one problem in order to influence the other areas by transference. What is meant by this is that by solving one area of concern the other areas may follow without any definite action.

The easiest and most suitable for control was the slow eating at meal times. The rest of the family took approximately 20 minutes to eat the evening meal. It was suggested that the boy be allowed 30 minutes to consume his meal and at that point his plate should be removed and in front of him the remaining contents should be deposited into the bin (waste garbage). This should be strictly maintained for each meal time including breakfast if this is also a problem. The intended outcome would be that the boy quickly realises that he has a time limit to consume his food. He should not be allowed any other food until breakfast time no matter how much he says he is hungry and upset. The parents with the support of the grandparents should not shout or scream but remain calm and ignore any pleas for more food. Although this may cause some distress to the child and parents initially once the boy sees this pattern happening everyday and without any let -up his “little professor” will go to work to find a solution to his discomfort. Within a week he will begin to speed up his eating and consume more in the allotted time span. It is important for the parents to praise him at each meal he manages to complete within 30 minutes but no other reward should be offered. The child will soon understand that positive attention comes as a result of following the new schedule for meals.

Children never really learn through direct punishment either physical or emotional however children often learn quickly when the threat of removing what they feel they need most is taken away. In addition to the meal times, all computer games should be withheld until homework is completed in a fixed time period. Even if he completes the homework if it is after the fixed time the games are still with-held. Different school assignments may take differing times and this should be agreed on before he starts.

At school the teacher must be made aware of the treatment plan and also comply with the same regime. At lunch time the boy is given a time limit for his lunch – in the beginning a little longer than other children but gradually reducing the time to fit in with eating norms. If, as at home, he takes longer the food should be taken away from him. In class the teacher should ignore his slowness to complete tasks and only focus on those children that are in fact complying successfully. By praising good behaviour and ignoring bad behaviour the teacher sets up an atmosphere of positive attention. The boy and other problem children quickly see that in order to gain attention they must first comply with the teacher’s demands. It is important for the teacher to notice good behaviour and improvements and give positive feedback to encourage further progress.

In this particular case study it is important to get the support of the grandparents as they may see the initial suffering of the child going hungry and not able to use his games or watch TV as cruel. This may lead to subversive behaviour by the grandparents to give the child secret snacks and so undermine the process.

Teachers in China while very competent in their subject areas have little child psychology understanding and in line with Chinese culture feel suppressive control of children though intimidation and threats of violence keeps good order in the class, much like the wider society here. Learning is mainly old-fashioned rote style through fear of failure to be able to repeat via memory all aspects of a subject with very little insight into the application of learning. This goes right up and beyond University teaching in China.


In this particular case study the child did improve but over a longer time scale than was initially envisaged by the psychologist, mainly due to three factors, the first the parents had become habituated to shouting at the boy and took some time to change to a calmer atmosphere. Second as anticipated the grandparents fought against the process wanting to spoil the child at every opportunity. Finally the school teacher failed to understand the process and through habit and poor teacher training continued to shout and scream at the students for failures in obedience matters.

Despite this as the psychologist suggested there was transference of learning from the meals to other tasks and the boy in fact after several weeks finished his meal at the same time as everyone else in the family. This transferred to his homework and the linking of his games to a withdrawal method when he failed to finish in a reasonable time.

The case is on-going with problems in the class-room persisting mainly to the lack of cooperation by the teachers.


In this case study we have tested out the idea from Eric Berne that a chid will change strategy in order to maintain attention seeking behaviour through the mental act of his “little professor” finding the most efficient way to receive that attention he craves. Although this case was in China the method of course is universal and works perfectly well in most societies. Withdrawal learning is based on the work of B. F. Skinner and operational behaviourism from the 1960’s. It is the understanding from Transactional Analysis combined with behaviourist techniques of positive reinforcement that enable parents to change disruptive behaviour to more rewarding and positive child rearing.

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